目的：了解左旋门冬酰胺酶（L-ASP）对儿童急性淋巴细胞白血病凝血功能变化的影响。方法：观察86例患儿在诱导缓解后治疗期间，L-ASP使用前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)、D-二聚体变化情况。结果：与用药前比,用药结束后一天的PT、APTT、TT均显著延长(P＜0.01);FIB、AT-Ⅲ显著降低(P＜0.01),D-二聚体显著升高(P＜0.01);用药结束后1周时PT、APTT、TT、D-二聚体较用药前差异无显著性,FIB、AT-Ⅲ虽有回升,但仍低于正常(P＜0.01)。结论：L-ASP可引起ALL患儿凝血功能异常，尤其对FIB、AT-Ⅲ影响明显，应引起临床高度重视。Ｌ-Ａｓｐ主要影响蛋白质的合成而引起蛋白质成份的凝血因子减少,从而引起凝血功能障碍,且对纤维蛋白原的合成影响更为显著。
Objective To search evidence in the treatment of Philadelphia chromosome （Ph）-positive acute lymphocytic leukemia （ALL） for guiding chnical practice. Methods We searched MEDLINE （February, 1970～July, 2005 ） and SUMSEAILCH （till July, 2005 ）to identify systematic reviews（SIL）, randomized controlled trials（RCTs） and controlled clinical trials （CCTs） in the treatment of Ph-positive ALL. Results One RCT and 8 CCTs were identified. The results showed that Ph-positive ALL had a very poor prognosis . Chemotherapy and bone marrow transplantation （BMT） were the two main ways to treat the disease. Outcome of conventional chemotherapy treatment for adults with the disease was poor. Outcome of treatment with hyper-CVAD and imatinib mesylate was better and BMT was the only way which could potentially cure the disease. Conclusions Treatment of Ph-positive ALL with hyper-CVAD and imatinib mesylate may induce higher remission rate and disease free survival rate. BMT is the best way to cure the disease.
Objective To assess the clinical effectiveness and safety of granulocyte colony stimulating factor (G-CSF) for patients with acute lymphoblastic leukemia (ALL). Methods We searched the Cochrane Library, PubMed, EMbase, CNKI, and VIP databases from January 2000 to October 2009. Randomized controlled trials (RCTs) about G-CSF for patients with ALL were retrieved. The methodological quality of the included studies was assessed and the data was extracted according the Cochrane Reviewer’s Handbook. Meta-analyses for overall survival, complete remission, quality of life, infections, relapse rate, and adverse events were performed using RevMan 5.0 software. Results Six RCTs involving 620 patients with ALL were included. The results of meta-analyses showed that the G-CFS group was superior to the control group in the overall survival of adult ALL patients (RR=2.24, 95%CI 1.28 to 3.90, P=0.004). Conclusion G-CSF can improve the overall survival of adult ALL patients. However, it is not demonstrated that G-CSF could improve complete remission rate and quality of life, and reduce infections and relapse rate. More high-quality and large scale RCTs are required.
ObjectiveTo report and analyze one case of Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) initially presented with skeletal destruction treated with imatinib-based personal therapy. MethodsWe described the therapeutic advancements for ALL cases initially presented as skeletal destruction and Ph+ ALL through case report and literature review. ResultsDefinite diagnosis of Ph+ ALL was made for the patient who subsequently obtained inductive remission and 17-month molecular remission with the aid of imatinib-based regimen. ConclusionWe should take potential diagnosis of ALL into consideration for patients with skeletal destruction. Imatinib-based standard chemotherapeutic regimen may improve therapeutic model and prognosis of Ph+ ALL.
ObjectiveTo explore the risk factors of nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy.MethodsThe children with acute lymphoblastic leukemia who were admitted to the Department of Pediatrics, Huai’an First Hospital Affiliated to Nanjing Medical University between December 2012 and December 2018 were divided into the infection group (including the severe infection subgroup and the non-severe infection subgroup) and the non-infection group according to whether nosocomial infection occurred during induction and remission chemotherapy. The clinical data of patients were collected. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of nosocomial infection during induction remission chemotherapy in children with acute lymphoblastic leukemia.ResultsA total of 96 patients were included. There were 67 cases in the infection group (26 in the severe infection subgroup and 41 in the non-severe infection subgroup) and 29 cases in the non-infection group. Univariate analysis showed that the granulocyte deficiency time and the prevalence of skin and mucosal damage in the infection group were significantly higher than those in the non-infection group, and the infection group had significantly lower laminar bed use and serum albumin level than the non-infection group did (P< 0.05). Multivariate logistic regression analysis showed that prolonged agranulocytosis [odds ratio (OR)=23.075, 95% confidence interval (CI) (3.682, 144.617), P=0.001], skin and mucosal lesions [OR=12.376, 95%CI (1.211, 126.507), P=0.034], hypoalbuminemia [OR=5.249, 95%CI (1.246, 22.113), P=0.024] were independent risk factors for nosocomial infection during induction and remission of childhood acute lymphoblastic leukemia, while laminar bed [OR=0.268, 95%CI (0.084, 0.854), P=0.026] was the protective factor.ConclusionsLong-term agranulocytosis, skin and mucosal lesions, and hypoalbuminemia are independent risk factors for nosocomial infection in children with acute lymphoblastic leukemia during induction remission chemotherapy. Laminar flow bed is its protective factor.
Objective To systematically review the pharmacoeconomic evaluation related to relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL), and to summarize its model structure, parameter inclusion and other methodological parts for future r/r B-ALL-related interventions, and to provide references for conducting pharmacoeconomic evaluations. Methods PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect relevant literature on the pharmacoeconomic evaluation model of r/r B-ALL from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data, and assessed the quality of the included studies. The data on the model structure, methods, and parameter inclusion were then summarized. Results A total of 10 studies using different modeling methods were included. Due to the lack of head-to-head trials, most of the efficacy parameters for the intervention and control groups were derived from different clinical trials and compared indirectly. All studies used quality-adjusted life years (QALYs) as output indicators, and some used life years (LYs) as output indicators and reported the incremental cost effectiveness ratio (ICER). All studies measured the cost of treatment and hematopoietic stem cell transplantation; a few studies also conducted subgroup analysis. Conclusion The number of studies on the economic evaluation of r/r B-ALL is relatively small, and there are large differences in model types, health status, and parameter inclusion. It is suggested that researchers should guarantee the integrity of the report format and normative according to available data choice drug economics evaluation model and establish the reasonable hypothesis under the condition of the patient population heterogeneity uncertainty, perform subgroup analysis especially on the subgroup which did not receive salvage therapy. In the absence of head-to-head clinical trials, appropriate indirect comparison methods are adopted according to the data obtained to reduce methodological differences and improve the quality of relevant pharmacoeconomic research in China.
【摘要】 目的 观察急性淋巴细胞白血病（ALL）患儿血清铁蛋白（SF）及β2-微球蛋白（β2-MG）水平变化，探讨SF和β2-MG水平变化对ALL患儿临床治疗效果的应用价值。 方法 对2008年7月-2010年4月期间血液病区住院确诊为ALL的患儿53例，病情得到控制缓解后的ALL患儿28例，分别抽取空腹静脉血进行SF和β2-MG测定，并选取正常健康儿童30例作为对照组。 结果 ALL患儿治疗前血清SF和β2-MG水平均高于正常对照组（Plt;0.01），经治疗缓解后ALL患儿的SF和β2-MG水平显著降低，并随着病情的转归而逐渐恢复至正常水平；与治疗前比较，差异有统计学意义（Plt;0.01）。 结论 SF和β2-MG可作为ALL临床治疗效果的有效监测指标。【Abstract】 Objective To observe the dynamic changes of Serum Ferritin(SF) and β2-MG levels in children with acute lymphoblastic leukemia(ALL) and to investigate its clinical significance on clinical curative effect. Methods Fifty-three in-patients with ALL, 28 relieved patients from July 2008 to April 2010 in our Hematology and 30 normal as control were selected in our study. The venousblood of patients and controls were extract in order to detect SF and β2-MG. Results Before the treatment, the level of SF and β2-MG in ALL group were significantly higher than those in the control group (Plt;0.01). After the treatment, the level of SF and β2-MG in ALL group decreased significantly (Plt;0.01), and they return to normal level gradually with the outcome; compared with before the treatment, the differences were statistically significant(Plt;0.01). Conclusion SF and β2-MG can be used as a helpful indicator to evaluate the therapeutic effect of ALL.